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Two putative sympathetic nervous system (SNS) markers, noradrenaline and neuropeptide Y (NPY) were related to 24-h ambulatory blood pressure (BP) in 59 normotensive subjects, 34 non-insulin-dependent diabetics, and 25 controls. Plasma NPY levels were not significantly different between the two groups [non-insulin-dependent (NIDDM) diabetes mellitus 4.33 (3.25-5.78), controls 5.68 (3.39-6.97) p=0.26] as were those of noradrenaline (1.51+/-0.69 versus 1.78+/-0.55; p=0.053). There were correlations, controlled for age and obesity, of plasma NPY with clinic and night time diastolic BP in the control group only (r=0.49 [p=0.013] and r=0.48 [p=0.023] respectively). No similar correlation was found in the NIDDM group, or between plasma noradrenaline and blood pressure in either group. No correlation was found between plasma insulin and NPY or noradrenaline levels. There is a weak independent relationship between NPY and blood pressure in normotensive nondiabetics but not in NIDDM subjects. We found no evidence for the hypothesis that insulin modulates blood pressure through activity of the SNS.

Defects of both sodium-hydrogen exchange (NHE) and sodium-lithium countertransport (SLC) have been described in subjects at increased risk of coronary heart disease (CHD). Sodium transport is linked to the regulation of cell volume, intracellular pH and cell growth, which may explain aspects of this association. However, impaired growth in early life is also linked to adult CHD, and 'programmed' alterations of cell behaviour are postulated to be responsible for this. In this study, therefore, we examined whether NHE or SLC in adults are predicted by anthropometric measures at birth, as well as being associated with insulin resistance syndrome (IRS) variables in adulthood. Red cell SLC was measured in 26 adults, and NHE in dermal fibroblasts from another 15 subjects characterized anthropometrically at birth. SLC activity correlated with LDL cholesterol, triglycerides and urate (r=0.42 - 0.49; 0.05P0.01), but not birth anthropometry. NHE V(max) correlated with plasma insulin (r=0.80; P0.001), but birth weight was unrelated to V(max), K(m) or Hill coefficient for H(i)(+). However, pH(i) correlated with birth weight (r=0.74; P=0.002), insulin sensitivity (r=0.52; P0.05), fasting glucose (r=-0.52; P0.05) 2 h insulin (r=0.51; P0.05) 2 h glucose (r=-0.54; P0.05). In conclusion, red cell SLC is related to IRS variables, but not with birth weight measures. In contrast, low intracellular pH(i) is related to both low birth weight and adult insulin resistance, suggesting it might be a 'programmed' cell phenotype, although this is not apparently explained by altered NHE kinetics.

A series of 50 patients treated with total cystectomy for transitional cell carcinoma is reported. The cases are grouped according to the histologic type and stage of the carcinoma. Forty-three patients had anaplastic carcinomas, of which 32 had invaded more than half of the bladder musculature (Stages P3 and P4). Twelve patients came to operation despite the presence of recognised distant metastases. Nine primary deaths occurred among 38 patients treated with radical surgery. When five years had elapsed, 8 of 29 patients were alive (28 per cent), of whom one had a recurrence in loco. The conclusion is drawn that cystectomy is best suited to tumours which have invaded to a depth of more than half the bladder musculature, or those with perivesical infiltration (Stage P3). However, the results hitherto recorded with supervoltage radiation are somewhat better than those obtained with cystectomy. The problems attached to urinary diversion following total cystectomy are considered briefly. Uretero-ileo-cutaneo...

The purpose of the present study was to establish viability criteria for hearts perfused with a non-biological synthetic perfusate in a Langendorff type preparation. During hypothermic perfusion, the only discriminant between eight undamaged and four hypoxically damaged hearts was resistance to perfusion flow. At near normo-thermic conditions, the damaged hearts exhibited a decreased respiratory rate. It was also suggested that adrenalin stress of the isolated heart might be useful instead of orthotopic transplantation, as a final test of viability.

In der offiziellen Statistik wird die Urogenitaltuberkulose erst seit 1956 registriert. Berechnet auf die Gesamtzahl der extrapulmonalen Tuberkulosen ist die Urogenitaltuberkulose in Schleswig-Holstein von 6,2% im Jahre 1956 auf 24,8% im Jahre 1963 angestiegen. Im gleichen Zeitraum hat die Belegung der extrapulmonalen Abteilung unseres Krankenhauses mit isolierten Nierentuberkulosen standig zugenommen, namlich von 12% auf 47% der Gesamtbelegung. Zwei Grunde werden fur die Zunahme der Nierentuberkulosen diskutiert: Von 503 Nierentuberkulosen, die bei uns behandelt wurden, konnte die Latenzzeit in 238 Fallen ermittelt werden. Sie erstreckte sich in 55% von 1 bis 10 Jahren in 31% von 10 bis 20 Jahren und noch in 8% von 20 bis 30 Jahren. Die Zunahme der Nierentuberkulosen werten wir als Ausdruck spater klinischer Manifestation jener in den ersten Nachkriegsjahren von 1945 bis 1950 stattgefundenen hamatogenen Aussaat frischer Lungentuberkulosen im Bereich der Nieren. Fur das Phanomen der Latenzzeit durften funktionelle und biochemische Besonderheiten des Nierenparenchyms verantwortlich sein, die kurz umrissen werden. Uber Behandlung und kontinuierlich kontrollierten Heilungsverlauf von 503 Nierentuberkulosen wird ausfuhrlich berichtet. Tuberkulose Ureterstenosen sind haufige Folgen der intensiven tuberkulostatischen Therapie. Ihre Behandlung mit Corticosteroiden ist in manchen Fallen erfolgversprechend.

Experience with human heart transplantation is reported. A technically successful infant heart transplantation was performed on December 6, 1967. The child died 612 hours postoperatively in severe metabolic and respiratory acidosis. Another heart transplantation was performed on January 5, 1968; the recipient was a 57-year old man. The donor heart was unable to support the circulation, and the patient died 1012 hours postoperatively. Problems in the selection of donors and of recipients, in the surgical technic, and in the postoperative management are discussed.

Ninety-three patients for whom a colorectal operation was planned had their bowel prepared mechanically by orthograde irrigation. The tube was sited in the duodenum via the pylorus under X-ray and TV control. The procedure was discontinued in 2 patients (2%), 15 patients (16%) experienced nausea and vomiting, while 76 patients (82%) experienced no discomfort. The mean duration of the irrigation was 216 min (90-476 min) and the mean volume of fluid used 10.21 (5.0 -15.0 1). There were no significant differences between pre-irrigation and post-irrigation blood chemistry. Twenty-three patients developed postoperative abdominal wound sepsis (26.7%), 4 (4.7%) had an intraabdominal abscess; 9 out of 12 patients (75%) had perineal wound sepsis. Escherichia coli and Bacteroides were the dominant species cultured from colorectal mucosa during operation as well as from infected abdominal and perineal wounds. Although the irrigation technique seems to clean the bowel to a degree not previously seen, this in itself is no guarantee of avoiding post-operative wound sepsis after colorectal operations.

Of 5000 patients with skeleton tuberculosis, 85 also had chest tuberculosis (= 1.7%). Chest tuberculosis in most cases begins with local pleural tuberculosis originating from a former moist pleurisy. The 5th rib is preferably involved, occasionally several ribs simultaneously. The gradual development of the abscess of the thoracic wall is mostly not recognized. Abscess incision only does not lead to recovery. Fistulas will be the result. Partial resection of the involved rib together with local decortication of the pleura is according to our experience the optimal therapy to obtain good results.

Oral therapy of prostatic tuberculosis so far has only been able to achieve conversion in one-fifth of the cases. Since 1970 we have practiced the transcutaneous injection of the prostate and have achieved conversion in all cases within a short time. Injection of 1 g Streptomycin and 0.1 g INH twice a week over a period of four to five weeks was carried out in 90 patients. Complications contraindicating the treatment was not seen. The transcutaneous injection treatment of the prostate is indicated in all patients where cavernous changes in the prostate have been demonstrated by urethrography.

A simple membrane oxygenator for isolated organ perfusion is described. The membrane employed consisted of an ordinary silicone rubber tubing, 2 mm internal diameter, 0.3 mm wall thickness, the length of the tubing varying according to the required gas transfer. When describing the capacity of the oxygenator, it was found that the maximum gas transfer rate per unit membrane surface was an inadequate measure, since this would vary with both flow rate through the oxygenator and the gas binding capacity of the perfusate. The following formula for the function describing the relation between maximally possible change in gas concentration in the perfusate (C), flow rate (F) and actual change in gas concentration in the perfusate (U) was proposed: U=C-e(-bF), b being a constant specific for the gas and the membrane. This formula was tested by a series of in vitro experiments and proved to give a valid description of the capacity of the oxygenator. It was also found that carbon dioxide was always more easily transferred than oxygen, so that oxygen transfer capcity was the limiting factor in the use of the oxygenator. To facilitate the construction of the right size membrane, a nomogram was constructed for oxygen transfer.

The amount of plasma cyclic adenosine-3',5'-monophosphate was estimated before and 15 minutes after the intravenous injection of 1 milligram of glucagon in 34 patients with obstructive and in 23 patients with nonobstructive jaundice. After stimulation with glucagon, the median adenosine-3',5'-monophosphate concentration in obstructive jaundice rose fortyfold or more, while in nonobstructive jaundice, the increase was twentyfold or less. The difference was highly significant. The results indicate that this test can be useful in the differential diagnosis of obstructive and nonobstructive jaundice.